Thursday, August 21, 2008

What I did this summer

Here are some excerpts from an essay by Ifedolapo Bamikole, a senior at UMass Amherst. She's from Nigeria and has been in the US for about 3 years. She is a biology and psychology double major, with interests in public health, international medicine, and health disparities. (Personal interests include piano, guitar, tenor sax, writing poems, and traveling.) She has spent two summers now shadowing people at BIDMC to learn about the workings of a major academic medical center. I think her observations are well written and insightful -- uncovering many of the issues we all face in the delivery of primary care -- and they will be helpful as she plans her career.

Another summer at Beth-Israel has come to a successful end after 12 weeks of projects, shadowing and observing at the hospital. My experience here last year encouraged me to come back, hoping to learn more. And I have definitely learned a lot more. The benevolence of some kind people has allowed me to be a summer intern here. But without the help, constant guidance, direction and knowledge of the people I worked with this summer, this whole summer internship would have been less than complete.

My mentors were Dr. Gila Kriegel and Dr. Carol Bates, same as last year. And I worked on 6 different projects: The Chlamydia screening, Pneuomax, Diabetes, narcotics, a time study project and health care proxy. These last 2 are on going right now. But for the 4 that have been completed this summer, the results and summaries were presented at QI meetings and panels of residents. These presentations were mostly for awareness purposes, to show how well HCA (our hospital-based primary care practice) is doing in taking care of specific patients, and highlighting areas of improvement. And after my work of collecting data, building a database and analyzing what I have, the intervention discussions that ensued from results presented at these meetings was always interesting to me, as I sit back, watch and listen to other people share their medical knowledge and come up with solutions to identified problems.

Before every project, I always got background information and education by one of the doctors to help me better understand what I was doing. Because of this I now know that women aged 25 and younger should be routinely screened for Chlamydia as this reduces the chances of pelvic inflammatory occurrences. In HCA 57% of women in this age group are being screened. This shows plenty of room for improvement. Among providers, there was no disparity in care given by resident or attending physicians in this area. Higher screening rates were found in Nurse Practitioners. This was a fact worthy of commendation to NPs. In order to see how well the practice was doing in the gynecological care of patients, I looked at the percentage of people who had received a Pap smear, as well as a Chlamydia screening and the result was nearly 80%, which is good.

The next project I worked on was the Pneumococcal vaccination which was quite similar to the last one in that I was to look for rates. Unlike the Chlamydia screening though, this involved looking at the older population (65 and older) who are at a high risk for pneumonia. And it was not gender specific. Here, I had a sample size of 100 patients to work with. And as I’ve learned, the bigger the sample size, the better for accurate figures people can actually work with. The results showed very good rates in general. 80% had received a pneumovax. And 83% were on Medicare which is normal and expected for this age group. There was not a big difference between English speaking and non English speaking rates of pneumovax. But when this was further broken down to male and female Non-English speakers, the difference jumps out at you as nearly 90% of male non English speakers got screened while a mere 56% of female non English speakers got screened. It was decided that this will be further looked into with an even larger population size to see if this remains true. Reasons why, along with solutions will be worked upon soon.

By the time I started on the Diabetes project and Narcotics project I had begun other things in the hospital. I took a class for observation status and then went to the West campus twice to observe a total of 4 different surgeries: Inguinal hernia repairs, a laparoscopic appendectomy and partial cecectomy, and one colectomy. The surgeon was Dr. Christopher Boyd and he happens to be a very nice man. He is a very funny man and was ready to explain things to me every step of the way, including why he was doing certain things and how he did it.

I observed, in Labor and Delivery, the arrival of a baby girl to new parents. It was their first child and my first time seeing a real delivery. The experience was nothing short of amazing. I felt like an important part of the team propping the woman up for the pushes, alongside her husband and helping her relax between contractions. The crowning of the baby’s head was just as fascinating as seeing the whole body come out so smoothly. And when the baby came out I was initially shocked at the color but watched the color slowly change as the baby took in oxygen in her lungs and steadily adjusted to life on this side of the world. The nurse I was assigned to was very kind in showing me all the procedures to make sure mother and baby stay in good shape. It took a while to wait for the placenta to come out. I was surprised at the large size of it. I never knew such big things could come out of a woman’s body. After the ‘second birth’, the woman had to have sutures to close up a very slight tear of about 2 inches. That is when I found out that obstetricians were also neat surgeons. And the invention of Epidural in medicine must be a blessing. This woman did not scream once throughout the ordeal.

I also got to shadow doctors. Dr. Anita Vanka and Dr. Diane Brockmeyer both graciously allowed me to sit in while they saw patients at different times. One thing I must have missed out last summer was how much a lot of these patients know about their conditions. Thanks to online information and research studies, the average patient is bombarded with a plethora of ideas, and it requires a doctor to be on her toes to envisage problems that could potentially arise from such knowledge and how to correctly advise such patients. A lot of my projects made even more sense when I started to see people in clinic with the kind of conditions I was working on. And along with the observation, I got a lot of teaching from the two doctors I shadowed, who made it a point of duty to know that I was learning something new always.

The diabetes projects was very time consuming but also very high priority because of the information that it gave. For residents it was necessary to see how well patients in their panels were having their diabetes adequately controlled. Because of the high risk for a myriad of other problems, diabetes patients need to be properly monitored by PCPs and followed up in Joslin. My results showed that there was a low number of NP visits (25% as opposed to 87% of PCP visits, in the last year). 61% of these patients were seen at Joslin Diabetes Center (Note: With whom BIDMC has a clinical partnership). But for a subset of people with hemoglobin A1Cs of ≥9, 100% were being seen at Joslin which is good. Foot exams need to be either carried out more and/or documented more as it is one of the important tests in diabetics, and the rate was only 45% (n=150). Suggestions were made at the resident meetings on how to make sure patients are getting all the necessary exams done.

My second summer back at Beth Israel Deaconess was definitely worth it. I had it reinforced in me every moment that time and accuracy was of the essence in this environment for efficiency. I can’t thank you enough for the opportunity to work here again. I am more encouraged than ever to finish my final year of college successfully and one day become like all these great doctors I have worked with.


Marion Platt said...

I'm just curious. Is it that easy for undergraduate students to shadow surgeons during operations? Does the woman who is giving birth know that non medical observers are in the room? Why are people who are of no benefit to the patient allowed to observe intimate or life threatening procedures just because they are curious about health care. I had no idea this was allowed, and frankly, I find it shocking.

Paul Levy said...

The student received special training before being allowed in a procedural area. You cannot casually walk in and observe an operation. But, yes, people who are not performing a medical function can be permitted in if it is part of a supervised educational program.